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Results for “urban design quality”

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At least 19 recordsLinked to original sources

PubMed2026

Urban Design Quality and Clinical Mental Health: A Systematic Review.

ObjectivesThis systematic review synthesizes empirical evidence on core urban design dimensions that affect clinical mental health outcomes and examines how environmental exposures mediate or moderate these relationships.BackgroundUrban design has increasingly been recognized as a determinant of psychological well-being, yet a standardized framework to evaluate its mental health impact remains underdeveloped.MethodsFollowing PRISMA 2020 guidelines, we systematically reviewed 19 quantitative empirical studies published through January 2025, examining relationships between outdoor urban design features and validated clinical mental health indicators across four major databases.ResultsFindings reveal that urban design influences clinical mental health outcomes (depression, anxiety, stress, cognitive decline) through two objective spatial scales: street-level features (imageability, enclosure, human scale, complexity) and neighborhood environments (land use mix, density, green infrastructure). Environmental exposures (traffic, noise, air pollution) operate as perceptual and experiential mechanisms that mediate or moderate the mental health effects of these spatial design features.ConclusionsWe propose an integrated three-domain conceptual framework distinguishing objective spatial design scales from subjective exposure mechanisms. This framework provides evidence-based guidance for urban planners and policymakers toward creating mentally healthier urban environments.

Humans↗

PubMed1989

[Health status of children from industrial cities with different regional geochemical structures].

Application of geochemical methods of urban environmental mapping made it possible to reveal pollution patterns typical for different cities. Based on the related geochemical and hygienic studies, a scale has been designed to evaluate the soil pollution level. Data on the possible changes in health status of the urban population that depend on the geochemical structure of the urban environment are presented. Recommendations on environmental design and quality control systems, and medico-administrative activities have been elaborated.

Child↗

PubMed1992

Impact of an emergency medicine residency program on the quality of care in an urban community hospital emergency department.

STUDY OBJECTIVES: To assess the impact of the introduction of an emergency medicine residency program on the quality of care in an urban community hospital emergency department. DESIGN: A retrospective chart review of all ED encounters for a three-month period beginning six months before and six months after the introduction of an emergency medicine residency. SETTING: A 27,000-visit-per-year urban community hospital ED. TYPE OF PARTICIPANTS: All patients who presented to the ED with one of five complaints and subsequently were discharged home. The five presenting categories examined were nontraumatic chest pain when age 30 years or more, lower abdominal pain in women aged 15 to 40 years, recent head trauma, headache of nontraumatic origin, and extremity laceration. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The frequency of physician documentation on the ED record of explicit criteria related to the five presenting complaints was used as a measure of the quality of care. Items sought for documentation included elements of the history and physical examination and diagnostic evaluations. The explicit criteria lists were drawn from the literature, including clinical policy guidelines. For each of the presenting complaints evaluated, documentation of the majority of items reflecting the quality of care was higher during the residency period. In no instance did the level of documentation decrease. CONCLUSION: As measured by a process evaluation, documentation of the medical record, the introduction of an emergency medicine residency significantly improved the quality of care in this urban community hospital ED.

Abdominal Pain↗

PubMed1990

Tertiary trauma care in a rural state.

Trauma patients in rural areas usually have no access to regional trauma systems or designated trauma centers. Efforts to provide quality trauma care in small hospitals may seriously overextend local capabilities. The urban trauma center retains an important role in trauma care even when the initial care must be provided at the local level. Twenty-five trauma patients were transferred to University Hospital between 1985 and 1988 after definitive care was initiated in community hospitals. During the same time period, a total of 147 trauma patients were transferred to the trauma service. No information was available on the total incidence of trauma. Medical records were reviewed to determine the reasons for transfer. Major reasons included the need for further complex surgery, better critical care support, and inadequate blood banks. Trauma centers serving rural areas provide a valuable resource well beyond the initial 24 hours.

Adult↗

PubMed1992

[The long-term record card, instrument for evaluating prolonged treatments].

OBJECTIVE: To find out the quality of extended treatments as recorded on the long-treatment medical record cards of the users of Chantrea Health Centre (Pamplona). DESIGN: This was a descriptive crossover study. SITE. An urban Primary Care centre. PATIENTS OR OTHERS PARTICIPANTS: The record cards filled in by registered nurses and physicians during one week in May 1990 were chosen. No prior notice was given to the rest of the team. Overall, 370 record cards were studied. MAIN MEASUREMENTS AND RESULTS: The average of drugs per person is 2.93 + 1.81, with significant differences for those over 65 years old (p less than 0.01). Regarding the quality indicators used: 78% of the medicines are included in the Primary Care Guide; 79.5% of those studied only took one drug; drugs were administered orally in 83% of cases; occasional concomitant medication was detected on 22.7% of the record cards and potential interactions existed on 35% of the cards. CONCLUSIONS: A therapeutic level, which was acceptable in terms of the indicators used, was supposed. For the Primary Care team to reflect jointly on prescriptions was thought to be important. The question was posed of a training programme for all doctors working in the area.

Aged↗

PubMed1985

A computer-assisted quality assurance system for an emergency medical service.

A busy urban emergency medical service answering more than 50,000 calls each year developed a plan for quality assurance using a computer-assisted model designed to employ a full-time quality assurance officer whose work was supplemented with computer evaluation of EMS field reports. The development of standardized reporting formats, protocols and computer programs enabled a significant improvement in detection of errors of documentation and patient care. Investigated cases rose dramatically in the month following implementation of the system, from five patient care errors per month to 35 (P less than .05), and from 50 documentation errors to 265 per month (P less than .05). Our experience indicates that computer-assisted evaluation of field performance, as judged by prehospital records, is a useful tool to ensure standards in patient care and EMS recordkeeping.

Allied Health Personnel↗

PubMed1985

Effects of water quality and water quantity on nutritional status: findings from a south Indian community.

Quantitative assessments of the relative effects on health of various aspects of water supply are virtually absent from the literature. Despite the lack of information, resources are being allocated throughout the developing world, for projects related to water and sanitation. The present study was designed specifically to overcome many of the methodological problems that other researchers have faced. Data were collected concerning the nutritional status of 627 children in three urban communities in South India. Information was also collected on water quality, water quantity, household sanitation, socioeconomic conditions, and housing. A statistical technique is presented that allows for controlling potential confounding factors in the analyses. The results, in general, indicate that at young ages (i.e., under 3 years old) water quality is relatively more important as a determinant of nutritional status, while at older ages water quantity is relatively more important.

Child Nutritional Physiological Phenomena↗

PubMed1992

Evaluating the treatment of sexually transmitted diseases at an urban public hospital outpatient clinic.

Sexually transmitted diseases occur disproportionately among the poor, are often treated in public hospitals and clinics, and have not been subjected to quality-of-care evaluation. We designed a medical record abstraction system using well-established, specific process-of-care criteria drawn from the medical literature and experts and grouped into three levels of quality: excellent, adequate, and minimal. One hundred seventy-six consecutive patients were identified from the clinic logbook and their medical records abstracted. Deficiencies in history taking, physical examination, laboratory testing, treatment, and public health reporting were identified.

Abstracting and Indexing↗

PubMed1991

An academic medical center's experience with mandatory managed care for Medicaid recipients.

This paper reports on The Hospital of the University of Pennsylvania's experience and concerns as a participating primary care site in a Medicaid managed care program (HealthPASS), which was established in 1986. Enrollment is mandatory for approximately half of Philadelphia's medical assistance population. Participating primary care sites receive monthly capitation for enrollees and serve as "gatekeepers" for specialty and inpatient services. The report discusses why the academic medical center chose to participate in the program and how existing activities were modified to meet both increased demand for primary care and increased administrative requirements. It also identifies characteristics of the HealthPASS program and of the medical center that have impeded effective case management of care for the urban poor population that the program serves. Improving the quality of care for the medically indigent while controlling costs is essential, but political realities and the special needs of the Medicaid population must be acknowledged. Increased attention must be given to the impact that political compromises have on the design and effectiveness of a managed care program.

Academic Medical Centers↗

PubMed1992

Audit of practice based cervical smear programme: completion of the cycle.

OBJECTIVES: To determine the effectiveness of a practice based cervical screening programme and the changing pattern of abnormal smear results and to improve the quality of care provided for patients. DESIGN: Audit of practice held data on cervical screening from 1980 to 1990. Changes in the programme were made after analysis of first five years' data. SETTING: Mixed urban and rural practice of 10,900 patients in Northumberland. SUBJECTS: Women aged 20-65 who had not had a hysterectomy. RESULTS: 2356 (85.1%) of the 2767 targeted women had a test during 1980-5 and 2498 (89.5%) of the 2790 women had a test during 1985-90. Inviting women aged 20-25 to attend for a test increased coverage from 45.8% (146/319) in 1980-5 to 82.5% (282/342) in 1985-90. The proportion of women with abnormalities requiring hospital referral rose in the second half of the study, especially among younger women (from 17/39 (44%) to 45/64 (70%) in women aged 25-34). CONCLUSIONS: Practice based cervical screening programmes can be highly effective. Cytological abnormalities affect patients psychologically as well as physically and practices should provide support and explanation for patients with abnormal results. Data from individual practices should be aggregated to allow health authorities to plan secondary care effectively.

Adult↗

PubMed1992

The quality of mercy. Caring for patients with 'do not resuscitate' orders.

OBJECTIVE: To assess (1) the effect of an ethics education intervention for medical house officers on practices surrounding "Do Not Resuscitate" (DNR) orders and (2) the association of DNR care with patient diagnosis and demographic variables. DESIGN: A 1-year randomized, controlled trial. SETTING: An urban, university teaching hospital. PARTICIPANTS: Eighty-eight internal medicine house officers. INTERVENTION: House officers were arbitrarily assigned to four "firms." One firm was randomized to an extensive ethics education intervention (EI), one to a limited intervention, and two served as controls. MAIN OUTCOME MEASURES: Charts of patients with DNR orders were reviewed for compliance with the hospital's DNR policy, which instructs that when DNR orders are written there should be (1) an attending signature, (2) documentation of reasons, (3) appropriate consent, and (4) attention to 11 concurrent care concerns (CCCs) (eg, the appropriateness of intubation, tube feedings, hospice). RESULTS: Thirty-nine charts were reviewed before the intervention and 57 after. The number of CCCs per DNR order fell among patients cared for by controls (1.9 to 1.0, P less than .05) and rose among patients cared for by the EI group (0.9 to 3.8, P less than .05). Compliance with the DNR policy varied among patients with differing diagnoses. "Do Not Resuscitate" orders were signed less frequently (P = .01) for patients with the acquired immunodeficiency syndrome (AIDS) (65%) compared with patients who had other diagnoses (85%) or malignancy (91%). Similarly, appropriate consent was recorded for 59% of patients with AIDS, 83% of others, and 85% of those with malignancy (P less than .05). The number of CCCs per DNR was 0.7 for AIDS, 1.4 for others, and 2.4 for malignancy (P less than .05). In multivariate regression analysis, house officer ethics education and patient diagnosis, but not patient gender, age, race, or insurance status, were predictors of the number of CCCs per DNR. CONCLUSIONS: (1) An extensive ethics education intervention can improve care for DNR patients, especially with respect to CCCs. (2) In this setting, quality of care for DNR patients varied systematically with diagnosis. These results have implications for the design and implementation of ethics education programs.

Baltimore↗

PubMed1990

Assessment of students' behavioral interactions during on-task classroom activities.

This study was designed to characterize the quality and quantity of interactions between students and significant others in the processing of new information during classroom activities. I wanted to test the hypothesis that black children, from moderate to low income urban environments, tend to have a more socially active cognitive style than their white peers in the performance of classroom tasks. Five different English classes, all 8th graders in a single junior high school (total of 114 black and white boys and girls), were observed in the same environment at different intervals to identify differences in the number of interactions between boys and girls, by racial groups. Classroom lessons and related activities were videotaped. The recorded activity was tabulated and rated by 3 trained observers. Black children more than white, and boys more than girls, initiated interactions with peers in the classroom in performing assigned tasks. This social interaction also showed that (1) 76% of the observed classroom time, subjects as a group were observed on-task and (2) pupils' interactions with their selected targets (classmates and their teacher) were 87% positive, and (3) relatively few interactions could be classified as disruptive.

Black or African American↗

PubMed2026

Health and Physical Activity Outcomes in Age-Friendly Cities and Communities: A Systematic Review of Emerging Evidence and a Future Research Agenda.

OBJECTIVES: The World Health Organization's (WHO) Global Network of Age-Friendly Cities and Communities (AFCCs) promotes the development of urban environments, policies and services that support the health and participation of older adults. This systematic review examined contemporary evidence concerning associations between WHO AFCC conditions and directly measured health and physical activity outcomes among older residents. METHODS: The registered review adhered to the PRISMA protocol for systematic reviews and meta-analyses and applied the Downs and Black quality criteria for randomised and non-randomised research. RESULTS: Structured Boolean searches of five research repositories identified 17 peer-reviewed studies published between 2017 and 2025 based upon original research conducted in WHO AFCC signatory cities. Although most studies reported positive associations between age-friendly features and domains, such as accessible transport, walkable environments, outdoor infrastructure and self-rated health or physical activity, the strength of evidence was limited by methodological inconsistency, variable study quality and reliance on self-reports. Barriers to evaluation included limited use of longitudinal or quasi-experimental designs, heterogeneous outcome measures, subjective response data and the challenge of establishing appropriate comparison conditions in complex municipal settings. CONCLUSIONS: Strengthening evaluation frameworks for AFCC initiatives is essential for evidence-based urban health policy and governance in rapidly ageing societies. A research agenda is proposed to strengthen AFCC evaluation through standardised measurement, community-based and mixed-methods research, and a greater commitment to co-designed assessment frameworks.

Humans↗

PubMed1989

[Epidemiologic study of allergy in the school environment].

A school environmental study of about 20,000 children from the French department of MAINE and LOIRE (1/100 of French territory and 1/100 of the total population) was made during the summer of 1987 in all the schools of the region. The replies allowed evaluation of: -- The elements of the environment; . urban or rural . type of building . soils . domestic animals (types, lifestyle, large or small, relationship with the children). -- The proportion of allergic children per classroom, types of sickness, suggestions made by parents, eventual allergic accidents during class hours. In addition, school teachers were asked to comment on the subject. Their answers showed extreme variety of attitude towards allergy, there were those who refuted it, some fully accepted and others who asked for more information so that they could be more help to their students. A prime interest of the study lies in the dialogue between parents, teachers and physicians as the children spent most of the daytime at school and therefore the quality of the environment is a major factor in infantile allergy.

Animals↗

PubMed1991

Hospital variables associated with quality of care for breast cancer patients.

OBJECTIVE: To determine the degree of compliance with clinical standards among hospitals for care of breast cancer patients and account for variations in compliance. DESIGN: Analysis of cancer registry data submitted to the American Cancer Society, Illinois Division, Chicago, for a concurrent prospective descriptive study of breast cancer, supplemented by other hospital data from public sources. SETTING: Ninety-nine Illinois hospitals evenly distributed among rural counties, counties with small cities outside the Chicago metropolitan area, exurban counties in the Chicago metropolitan area, suburban Cook County, and urban Chicago. PATIENTS: A total of 5766 newly diagnosed patients with histologically confirmed breast cancer in 1988, representing 84% of the estimated 6900 new cases in the state for that year. MAIN OUTCOME MEASURES: Descriptive statistics and multiple linear regression analyses of five dependent quality variables from clinical indicators related to early diagnosis, hormone receptor determination, adjuvant therapy, radiation therapy, and axillary lymph node dissection. RESULTS: At the hospitals studied, (1) late stage (IIb through IV) at diagnosis was associated with urban location, higher proportion of poorly insured patients, fewer breast cancer cases treated, and lower oncology charges (proportion of variance explained, R2 = .50, P less than .00001); (2) omission of hormone receptor test for stages II through IV was associated with urban location and higher proportion of poorly insured patients (R2 = .18, P less than .00003); and (3) omission of indicated radiation therapy was associated with urban location and fewer breast cancer cases (R2 = .21, P less than .00001). Omission of adjuvant therapy and omission of axillary lymph node dissection were not significantly associated with any of the hospital variables examined. CONCLUSIONS: The findings suggest that there is a group of urban hospitals, generally small and marginally reimbursed, where comprehensive diagnosis and treatment of breast cancer are not obtained.

Breast Neoplasms↗

PubMed1990

Predicting in-hospital survival of myocardial infarction. A comparative study of various severity measures.

This study reports on the ability of several indices to predict in-hospital survival from acute myocardial infarction. The following indices were included: Acute Physiological and Chronic Health Evaluation (APACHE II), Medisgroups (MDGRP), Computerized Severity Index (CSI), Patient Management Categories (PMC), Coded Disease Staging (CDS), Ischemic Heart Disease Index (IHDI), and Predictive Index for Myocardial Infarction (PIMI). An arbitrary strategy of predicting that all patients will live was also applied and correctly classified 78% of the cases. Severity indices improve these predictions by up to 6% more. Comparison of relative accuracy of the indices showed that all indices were more accurate than PIMI and, for medically treated patients, CSI was more accurate than MDGRP, CDS, APACHE II, and IHDI. There were no other statistically significant difference in the predictive ability of remaining indices. Indices based on discharge abstracts were as accurate as some of the indices based on physiologic variables, in particular PMC was as accurate as CSI, MDGRP, APACHE, and IHDI, and CDS was as accurate as MDGRP, APACHE, and IHDI. This study was limited in scope and application and should not be generalized to other settings until additional data confirm the findings. We discuss the implications of these findings for measuring quality of care and suggest improvements for design of future severity indices.

Adult↗

PubMed1979

A proposed network to improve access to high-quality health care for Medicaid-eligible families.

There is today both a need and an opportunity to develop and test a variety of models--organizational and financial--for improving the delivery of health care services. This article describes the structure and functioning of one such model and highlights the organizational problems expected to arise during its implementation. The proposed health plan is intended to facilitate the access of Medicaid-eligible, inner-city families to already available health services. The central hypothesis is that in low-income urban areas the elementary schools offer an organizational focus for the development of a health plan. As a prepaid, community-based model, this plan is designed to address the issues of accessibility, equity, accountability, continuity of care, and consumer participation, primarily through the development of a coordinating agency, the health plan office (HPO), which assures the linking of consumers and providers of health care. Adapted from the Kaiser-Permanente model, the HPO also assumes responsibility for marketing, enrollment, coordination of services, consumer advocacy, and quality surveillance.

Child↗

PubMed1992

[Coverage of 4 health programs for pre-school children in marginal urban areas in Mexico City].

The aim this paper was to evaluate the coverage provided by four preschool child health programs (vaccinations, oral hydration therapy, healthy child care and sick child care). To make coverage operational, we designed indicators to compare the utilization of each program with the condition or health problems considered as needed. These results are part of a broad evaluative research called "Coverage and Quality of Primary Health Care" (CQPHC) carried out by the National Institute of Public Health (NIPH) in the State of Mexico in 1988. The population under study was a random sample of the total of preschool children detected in the household survey. We only analyzed data including children from 1-4 years to ensure that all studied children had completed the basic vaccination schemes. For the vaccination program, we observed a coverage of 47.7%, twice as much as that of the oral hydration program that only reached was 21.9%, whereas that of the sick child care program was 63.8%, the former being 2.0 times less than the latter. We can conclude that the different coverage found for each program is basically due to the lack socialization of the concept of need and to the extent of participation of the concept to make these services available to the population.

Child Health Services↗